Cardiology Coding Alert

Reader Question:

Peripheral vs. Coronary Interventions

Question: Can you help us determine the coding between peripheral intervention (PTA and stent) and coronary intervention (atherectomy and coronary stenting)?

Anonymous MN Subscriber

Answer: An angioplasty is defined as a reconstitution or recanalization of a blood vessel; may involve balloon dilation, mechanical stripping of intima, forceful injection of fibroinolytics, or placement of a stent, while an athrectomy is removal or excision of yellowish plaques of cholesterol, lipids, and cellular debris in the inner layers of the walls of arteries, says Karen Youmans, MPA, RRA, CCS, a manager in the coding products and services division of the American Health Information Management Association (AHIMA). According to Coding Clinic 4Q 1995, intravascular stents are tubular metal implants which are designed to restore normal blood flow by reopening or enlarging a blood vessel. Stents have also proven to be of significant value in treating threatened or abrupt vessel closure, thereby reducing the need for emergency surgery. The Coding Clinic article goes on to state that stent procedures may be performed in a catheterization laboratory by physicians or surgeons trained in interventional techniques in the inpatient and/or outpatient settings.

For a PTCA with stent, the stent is attached to a catheter and delivered to the site of the narrowed vessel via introduction through a peripheral vessel (such as the femoral or brachial artery) to the specific coronary vessel(s). CPT code 92980 is assigned for the transcatheter placement of an intracoronary stent for a single vessel. Code 92981 may be added to code 92980 if stents were placed into additional vessels. The arthrectomy or angioplasty is inherent in the placement of a stent and cannot be billed separately. For a coronary angioplasty, either code 92982 or 92984 (depending on the number of vessels involved) would be assigned. For a coronary arthrectomy, either code 92995 or 92996 (again, depending on the number of vessels involved) would be assigned.

A peripheral angioplasty is performed on a non-coronary vessel. A PTA is a percutaneous transluminal angioplasty or atherectomy of non-coronary vessel(s). Angioplasties may be performed on peripheral arteries (such as a radial artery for renal dialysis) as well as iliac, femoropopliteal, vertebral, renal and mesenteric arteries. There is a range of CPT codes (35470-35476) for transluminal balloon angioplasty, percutaneous, depending on the site of the vessel. CPT codes 35490-35495 describe percutaneous transluminal peripheral arthrectomies. In addition, either code 37205 or 37206 is assigned for the placement of the non-coronary stent.